Transcaval access for TAVR across a polyester aortic graft

Transcaval access to the aorta allows transcatheter aortic valve replacement in patients without other good access options. The resulting aorto‐caval fistula is closed with a nitinol cardiac occluder device. There is no experience traversing a synthetic aortic graft to perform transcaval access and closure. We describe a patient who underwent successful traversal of a polyester aortic graft using radiofrequency energy applied from the tip of a guidewire, to allow retrograde transcatheter aortic valve replacement from a femoral vein, along with details of our technique. The patient did well and was discharged home after 3 days. There was residual aorto‐caval fistulous flow immediately after implantation of a polyester‐seeded nitinol muscular ventricular septal defect occluder device, but this fistula spontaneously occluded within one month. © 2015 Wiley Periodicals, Inc.